Search

Much is still unknown about LUT function after receiving renal graft. Graft function was the main focus of different studies discussing the same issue. However, these studies ignored the effects of the graft on lower tract function and more demand for bladder cycling and growth of the child. Therefore, we aimed at evaluating the LUT function after RT into patients with LUTD. We enrolled a retrospective cohort of 83 live renal transplant children with LUTD. The 44 patients in Group (A) had a defunctionalized bladder, and the 39 patients in Group (B) had underlying LUT pathology. All patients had clinical and urodynamic evaluation of LUT functions at least 1 year after RT. We found that the improvement in patients with impaired bladder compliance was 73% in Group (A) and 60% in Group (B), with no statistically significant difference between the study groups. In Group (B), there was statistically significant worsening of MFP (8.4%) and mean PVR (79.9%) after RT. In Group (A), mild but stable significant improvement of all clinical and urodynamic parameters was observed. Serum creatinine was significantly worse in patients with pathological LUTD compared with those with defunctionalized bladder but without significant effect on graft survival. All LUT variables seemed to have no adverse effect on graft survival except for use of CIC and augmented bladder. Incident UTI independent of LUT variables accounted for 20% of graft creatinine change.

Background To assess the efficacy and durability of percutaneous posterior tibial nerve stimulation for the treatment of the overactive bladder in children. Results Twenty patients with a mean age of 7 ± 3.3 years were included in the study. Subjective success was found in 12 patients (60%) who considered their situation to be better and requested to continue therapy to maintain the response which was considered as a therapeutic success, while eight patients (40%) patients chose not to continue therapy because they did not have symptomatic improvement. Conclusion Posterior tibial nerve stimulation is an effective, minimally invasive method for treatment and is easily applied to induce improvement in overactive bladder symptoms and objective urodynamic changes with negligible side effects.

Summary Objective Our aim was to evaluate the effectiveness of anterior osteotomy in the restoration of normal pelvic floor anatomy in classic bladder exstrophy repair using pelvic floor MRI as an imaging tool for evaluation. Patients and methods This study is a pilot prospective randomized controlled study that included 20 infants with classic bladder exstrophy older than three months with no history of previous surgical operations. All patients underwent complete primary repair and were randomized into two groups, with or without osteotomy. Both groups were assessed preoperatively & postoperatively after three months with pelvic floor MRI and compared to age & gender-matched control group infants with normal pelvic anatomy infants who underwent pelvic MRI for other medical conditions. Results There was not any significant statistical difference between osteotomy and non-osteotomy groups in pre-operative demographic data and all pelvic floor MRI measurements, emphasizing that both groups were equal in all characters at the start point of the study before the operation. The mean change difference between pre-operative and post-operative pelvic floor MRI measurements were compared in both groups, and there was not any significant statistical difference in all pelvic floor MRI measurements. Both groups showed the same statistical significance when compared with the control group in all pelvic floor MRI measurements except the posterior bladder neck distance, which was in favor of the osteotomy group, closer to the normal pelvic floor anatomy. Conclusions Anterior osteotomy did not have a significant difference in the restoration of the normal pelvic floor anatomy when combined with complete primary repair of classic bladder exstrophy in newly diagnosed neonates older than three months, except for a single measurement, posterior bladder neck distance. Future studies needed to determine the effect of osteotomy on continence. Summary table . Pre-operative measurements Mean change postoperative Group (A) (n = 8) a Group (B) (n = 8) Group (C) (n = 6) Group (C) vs. Group (A) (n = 8) a Group (B) (n = 8) p value Patients (n = 16) a Control (n = 6) p value Group (A) P-Value Group (B) P-Value Symphyseal diastases 2.81 ± 0.70 3.10 ± 1.38 0.52 ± 0.13 0.002 a 0.003 a −1.01 ± 0.44 −0.84 ± 0.63 0.140 2.96 ± 1.07 0.52 ± 0.13 0.001 a Puborectalis angle 83.78 ± 16.77 96.23 ± 17.37 91.08 ± 8.26 0.197 0.796 2.69 ± 13.78 3.20 ± 17.39 0.997 90.00 ± 17.70 91.08 ± 8.26 0.555 Ischial angle 54.71 ± 9.72 58.40 ± 11.49 48.17 ± 5.60 0.220 0.053 9.64 ± 4.14 7.60 ± 3.40 0.269 56.56 ± 10.45 48.17 ± 5.60 0.071 Obturator to Levator angle 36.60 ± 6.73 39.61 ± 7.37 46.48 ± 2.66 0.007 a 0.020 a −7.70 ± 12.04 −11.88 ± 11.77 0.713 38.11 ± 6.99 46.48 ± 2.66 0.004 a Posterior bladder neck distance 3.69 ± 0.67 3.87 ± 0.40 3.18 ± 0.43 0.093 a 0.017 a 0.44 ± 0.16 0.57 ± 0.36 0.165 3.78 ± 0.54 3.18 ± 0.43 0.020 a Data are expressed as mean ± SD. P-Value ≤0.05 = statistically significant. Table showing a comparison between some of the pelvic floor MRI measurements in the three studied groups. Group A: Patients with complete primary repair and osteotomy, Group (B): Patients with the complete primary repair without osteotomy, Group (C): Control group. a Four patients from group A were excluded as they experienced dehiscence.

Summary Introduction Causes for end stage renal disease (ESRD) in children can be categorized into urological causes or non-urological causes. We sought to compare the outcomes of urological and non-urological causes of ESRD in children. Methods Patients were divided into two groups: urological causes of ESRD versus non-urological causes of ESRD. All patients and donors had at least 6 months of follow-up. The main outcomes included the effect on complications and renal function. Comparisons were carried out using the chi-square test or the Student t-test. Multivariate logistic regression analysis was used to define the effect of different variables on the outcome of renal transplantation ( Table ). Results Our study included 123 patients, 91 males. The mean age was 9 years and mean follow up was 46 months. Two-thirds of the patients had non-urological causes of ESRD. Overall survival was 100%, and only one patient needed a graft nephrectomy 3 months after the transplant. The mean estimated glomerular filtration rate was 117 mL/min, and did not differ significantly between the two groups (p = 0.13). Multivariable regression showed that female gender (OR 8.7, 95% CI 2.9–26, p = 0 0.0001) was associated with better renal function, while having a urological cause of ESRD (OR 0.28, CI 0.08–0.98, p = 0 0.05) was associated with worse renal function. Non-urological causes of ESRD were significantly less likely to develop complications following renal transplantation (OR 0.28, CI 0.09–0.89, p = 0 0.03). Conclusion Female patients with non-urological causes of ESRD are more likely to have better long-term renal functions, and less liable to develop complications following renal transplant. Table . Multivariable regression model (stepwise method) for prediction of factors that may affect the renal functions and postoperative complications following transplantation. Variable Odds ratio 95% CI p Renal functions Sex 8.7 2.90–26.00 0.0001 Urological causes of ESRD 0.28 0.08–0.98 0.05 Postoperative complications Non-urological causes of ESRD 0.28 0.09–0.89 0.03 Note. Factors included in the univariate analysis: age, sex, weight, cause of ESRD (urological vs. non-urological), pre-emptive transplantation, dialysis prior to transplantation, gender of donor, gender of recipient. CI = confidence interval; ESRD = end-stage renal disease.

Openness, applied in scholarly and research practices, has garnered increasing interest in recent years. With the broadening reach of Open Access as an alternative scholarly publishing model, there is anticipation that open scholarship practices will produce desirable outcomes for research and access to knowledge. The purpose of this article is twofold: firstly to highlight that Open Access is more than just the removal of paywalls, and that it is part of a wider set of open practices that can potentially yield a more collaborative and equitable global landscape of knowledge production. Secondly, to present the IDS Bulletin as a case study for an Open Access publication that has evolved to adapt to a changing scholarly publishing landscape. By critiquing prevalent discourse on openness alongside this case study, we hope that this article contributes to conversations on issues at the intersection of open scholarship, collaborative research and equitable access to knowledge.

There is some reluctance to use dermal grafts for augmenting the tunica albuginea to correct severe forms of chordee. The main concern is that by violating the integrity of the tunica albuginea venous leakage could presumably ensue and result in erectile dysfunction. We present our long-term followup of dermal grafts used to correct severe penile curvature associated with hypospadias or as an isolated malformation.A total of 16 patients received a single dermal graft harvested from the nonhair bearing inguinal skin fold. Patient age was 1 to 19 years (average 7). Of the patients 14 had hypospadias, which was scrotal in 12 and perineal in 2, while 2 had congenital penile curvature. In the hypospadias group 13 patients underwent primary repair and 1 had undergone 2 previously failed repairs with persistent severe curvature. Additionally, 5 patients in the hypospadias group had associated penoscrotal transposition. Eight patients in the hypospadias group received testosterone injections preoperatively.Average followup was 10 years (range 6 to 15). At the time of the study all patients were postpubertal and 3 had married. Evaluation of the results was based on patient interview reporting of penile straightness, erectile quality and satisfaction with sexual relations, if present. Two of the 3 patients who married reported satisfactory sexual activity and 1 had fathered children. The other 13 patients reported rigid erections. Two patients had mild residual curvature that would not necessitate any further intervention.Some boys with severe penile curvature, particularly those with hypospadias and a borderline size phallus, need a dermal graft rather than a plication procedure to correct curvature. Our study suggests that using dermal grafts is safe for erectile function.

Objective We present our experience of management of high-grade renal trauma in a pediatric population, including assessment of the long-term function and morphology of the ipsilateral kidney. Patients and methods From 1997 to 2005, 40 children with high-grade renal injury (III, IV, V) after blunt abdominal trauma were managed. Initial evaluation included vital signs, color of urine, hemoglobin (Hb%), hematocrit, serum creatinine and computed tomography (CT). Follow up included vital signs, urine analysis, Hb%, CT, ±intravenous pyelogram and renogram. Results One patient needed superselective embolization due to continuing hemorrhage in spite of conservative treatment. Internal stenting plus percutaneous tube drain was indicated in three cases due to progressive extravasation. Exploration was indicated in four cases, one at presentation due to hemodynamic instability which ended in nephrectomy; the other three were successfully repaired. Conservative treatment was successful in 32 cases (80%). Blood transfusion was indicated in 16 cases (40%). Length of hospital stay was 4–20 days (mean 12.1). At the last follow up (range 1–8 years, mean 3.5), scars were detected in 10 cases, while all showed normal levels of Hb% and creatinine. No patient developed hypertension. Apart from in the nephrectomy case, the ipsilateral kidney showed split function of 40–50%. Conclusion After exclusion of hemodynamic instability and continuing hemorrhage, conservative treatment is successful in 80% of patients. Internal stenting with or without percutaneous drainage is indicated if there is progressive urinoma. Angioembolization is successful in selected cases.

Summary Background Although staged repair for reconstructing severe hypospadias is more popular, various one-stage repairs have been attempted. Koyanagi repair (parameatal-based and fully extended circumferential foreskin flap urethroplasty) has enabled correction of severe hypospadias in one stage. However, its un-acceptably high incidence of complications has initiated a series of technical modifications, including the “yoke” repair. Objectives To retrospectively analyze the outcome of a proposed modification of the originally described yoke repair, for patients with severe hypospadias. This modification was developed to reduce complications. Study design Over 4 years (between Jan 2011 and Jan 2015), all cases of severe hypospadias were included in this study; except those with prior attempts at repair, circumcised cases, and cases with severe hypogonadism – because of partial androgen insensitivity - not responding to hormonal manipulations. The make-up of the neo-urethra in this modification is the urethral plate with its spongiosal tissue proximally, a circum-coronal preputial pedicled flap in the middle, and an incorporated part of the augmented preputial flap and the preserved V-shaped glanular urethra, distally. Close postoperative follow-up was conducted to investigate the outcome. Results Thirty-one children with a median age of 32.48 months had repair of severe hypospadias using the neo-yoke technique. After a median follow-up of 26.7 months, the overall complication rate was 16.1%. Four children developed urethrocutaneous fistula (12.9%). Meatal drop-back occurred in one case (3.2%). No meatal stenosis or urethral sacculation was detected during follow-up of the studied group. Almost all cases had cosmetically appealing outlook. Single-staged repair of severe hypospadias using parameatal foreskin-based urethroplasty has passed through different modifications, all aimed at optimizing the outcome ( Table ). Conclusion Neo-yoke repair for severe hypospadias is a natural development of established one-stage techniques, which resulted in better mid-term outcomes. However, an extended study is needed to declare the long-term results. Summary Table . Development of single-staged parameatal-foreskin based urethroplasty (PFU) Authors Procedure name Flap design Studied series Results Overall success rate Complications Koyanagi et al., 1994 [8] Original Koyanagi-Nonomura technique Two parallel parameatal skin flaps extending distally into the inner-face prepuce, supplied solely by perimeatal spongiosal tissue 70 53% Ischemic long skin flaps resulted in strictures, fistulas, and disruptions Snow and Cartwright, 1994 [9] Yoke hypospadias repair All resembled a yoke drawn around the glans penis, being richly supplied by perimeatal spongiosal tissue and preserved preputial vascular pedicle 4 50% 2 penoscrotal fistula Emir et al., 2000 [16] Modification of the Koyanagi technique 20 80% 4 urethrocutaneous fistula Hayashi et al., 2001 [17] Modified Koyanagi repair 14 70% 3 urethrocutaneous fistula 3 meatal stenosis Hayashi et al., 2007 [15] Neo-modified Koyanagi technique Divided the yoke at 12 o'clock to the root of penis, then rotated ventrally to be sutured to the sides of distally retracted urethral plate 12 92% 1 urethrocutaneous fistula 0 meatal stenosis Presented study Neo-yoke repair The urethral plate with its spongiosal tissue being retracted proximally, a circum-coronal yoke in the middle, and interdigitation of dorsally augmented preputial flap and V-shaped glanular urethra, distally 31 84% 4 urethrocutaneous fistulas 1 meatal drop-back

To determine the safety and efficacy of extracorporeal shock wave lithotripsy (ESWL) as monotherapy for renal stones25 mm in children.Our prospective study included 24 children14 years old with radiopaque renal stones25 mm treated by ESWL as first-line treatment using the electromagnetic Dornier DoLi S device. Pretreatment kidney, ureter, and bladder plain films and intravenous urography and post-treatment ultrasonography and kidney, ureter, and bladder plain films were used to monitor the clearance of fragments. Stone clearance was assessed at 1 and 3 months. A stone-free state was defined as no radiologic evidence of stone. Asymptomatic noninfectious and nonobstructive fragments3 mm were considered insignificant.The 24 children, aged 2-14 years (mean 7) underwent 53 ESWL sessions. Of the 24 children, 10 had stones located in the left kidney and 14 had stones located in the right kidney. The stone size was 25-35 mm (average 31). The average number of shock waves was 3489 per session. All children underwent lithotripsy with a gradual incremental energy increase from 14 to 20 kV. The overall stone-free rate was 83.3%. Four patients had clinically insignificant fragments and were followed up for the possibility of stone regrowth, microscopic hematuria, and urinary tract infection. Complications affected 25% of patients.ESWL is highly effective for treatment of large renal stones in children as a first-line treatment with minimal morbidity. The placement of a stent is not a prerequisite for success of treatment.